A press release from Joe Carr's opponent makes a case:

 Rep. Joe Carr (R-48) not only supports the implementation of Obamacare, but even co-sponsored legislation that fast-tracks the Patient Protection and Affordable Care Act drastically increasing government healthcare spending in Tennessee.

The bill Rep. Carr sponsored, HB 0369, is an inter-state health care agreement (compact) requiring Congressional approval and would be the first step in implementing Obamacare at the state level. Legislators plan to administer the state’s Obamacare program via TennCare and it is expected to cost taxpayers more than $1.2 billion in new spending of state and federal funds. (See Section 1331 and 1333 of the PPACA and the HB 0369 fiscal note)

 “What is important to realize is that the health care compact Mr. Carr supports is not an alternative to Obamacare-- it is actually part of Obamacare,” said Ryan Harring, challenger in the 48th district. “Although on the surface it sounds better for Obamacare to be directed by the state government, the reality is that it will still cost taxpayers more than $1 billion of new deficit spending. The legislature should instead be refusing Obamacare’s entitlement spending in Tennessee rather than rushing to implement it.”

The Supreme Court’s ruling on Obamacare limited the federal government's ability to force state governments to expand their Medicaid program. According to Michael Cannon, Director of Health Policy Studies at the conservative Cato Institute, “State governments are really in the driver's seat here.” Cannon said. “They can effectively stop the new spending under this law just by refusing to create an exchange and by also refusing to expand their Medicaid programs."

A paid advertisement placed by Rep. Carr’s campaign last week stated that he will continue to support the Obamacare-compliant health care compact...

“I don’t think that Mr. Carr’s history of big spending and his misuse of taxpayers’ money are the kind of ‘solutions’ that Tennesseans are hungering for,” Harring said. “What we need is an elected official who will fight Obamacare at the state level rather than having a ‘go-along to get-along’ approach with President Obama.”

Harring continued, "When elected to the Tennessee House I will fight against Obamacare in every form whether it is an insurance exchange, a health care compact, or any other type of back-door attempt to bring President Obama's policies to Tennessee"